Pahouja Gaurav, Wesolowski Robert, Reinbolt Raquel, Tozbikian Gary, Berger Michael, Mangini Neha, Lustberg Maryam B
Northeast Ohio Medical University, College of Medicine, Rootstown, OH 44272, USA.
Breast Program, Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, USA.
Cancer Treat Commun. 2015;3:28-32. doi: 10.1016/j.ctrc.2014.11.002.
Complete bone marrow infiltration with profound pancytopenia is very uncommon in breast cancer. Bone marrow metastasis can frequently occur following development of metastatic breast cancer. However, bone marrow failure as the herald of this disease is not typically seen. Very limited data exists as to the safest and most efficacious manner to treat patients with profound pancytopenia due to metastatic solid tumor involvement. In this case, the patient's thrombocytopenia was particularly worrisome, requiring daily platelet transfusions. There was also concern that cytotoxic chemotherapy would exacerbate the patient's thrombocytopenia and increase bleeding risk. The patient's dramatic response to chemotherapy with full platelet recovery is also highly unusual. For our patient, continuous doxorubicin successfully "unpacked" the bone marrow despite a low baseline platelet level, and without increasing the need for more frequent platelet transfusion or risk of catastrophic bleeding. Given the rarity of this presentation, it is currently unknown if the majority of similar patients experience near full recovery of hematopoietic function after initiation of appropriate systemic treatment for metastatic disease.
乳腺癌出现全血细胞减少伴骨髓完全浸润的情况非常罕见。骨髓转移常在转移性乳腺癌发生后频繁出现。然而，骨髓衰竭作为这种疾病的先兆并不常见。关于治疗因转移性实体瘤累及而出现严重全血细胞减少的患者最安全、最有效的方式，现有数据非常有限。在这个病例中，患者的血小板减少尤其令人担忧，需要每日输注血小板。此外，人们还担心细胞毒性化疗会加重患者的血小板减少并增加出血风险。患者对化疗有显著反应且血小板完全恢复，这也非常不寻常。对于我们的患者，持续使用阿霉素成功地“解开”了骨髓抑制，尽管基线血小板水平较低，且未增加更频繁输注血小板的需求或发生灾难性出血的风险。鉴于这种表现的罕见性，目前尚不清楚大多数类似患者在开始针对转移性疾病进行适当的全身治疗后是否会出现造血功能近乎完全恢复的情况。
